Attachment_16_-_Relevant_Experience_Project_Template_AMD0002.docx
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Securities and Exchange Commission
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Attachment 16 - Relevant Experience Project Template_AMD0002
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Text version
Attachment 16: Relevant Experience Project Template (Document Verification)
Part 1: Project Identification
| Contractor Name: |
| Click here to enter text. |
| Contract Number: |
| Click here to enter text. |
| Order Number (if applicable) |
| Click here to enter text. |
| Project Title: |
| Click here to enter text. |
| Prime or Subcontractor: |
| Choose an item. |
| Contract Type: |
| Choose an item. |
| Period of Performance (PoP): |
| MM/YYYY – MM/YYYY or MM/YYYY - Present. |
| PoP if all options are exercised: |
| Choose an item. |
| Obligated Amount: |
| Click here to enter text. |
| Base and All Options Value (Total Contract Value): |
| Click here to enter text. |
| NAICS: |
| Click here to enter text. |
| PSC Code |
| Click here to enter text. |
Part 2: Project Reference Information
Contracting Officer (or Corporate Official for Commercial Experience)
| Name: |
| Click here to enter text. |
| Title |
| Click here to enter text. |
| Agency or Customer: |
| Click here to enter text. |
| Phone: |
| Click here to enter text. |
| Email: |
| Click here to enter text. |
Contracting Officer’s Representative (Complete only if COR providing signature verification in Part 3)
| Name: |
| Click here to enter text. |
| Title |
| Click here to enter text. |
| Agency: |
| Click here to enter text. |
| Phone: |
| Click here to enter text. |
| Email: |
| Click here to enter text. |
Part 3: Project Description (Narrative limited to one (1) page) (If performed as Subcontractor, explain your role in accomplishing the project objectives)
Click here to enter text.
Part 4: Project Verification
Verification Method – Choose One
| ☐ | FPDS | |
| ☐ | Signature of reference identified in Part 2 |
Convert to .pdf prior to signing. Signature below by a Contracting Officer , Contracting Officer’s Representative, or Corporate Official constitutes acceptance of the above project information to be accurate as ordered and received by the listed entity. Signature by Contracting Officer’s Representative must include copy of email notification to the cognizant Contracting Officer.
Name: Click here to enter text.
Date: Click here to enter text.
Signature:
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